Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia

作者：Labrosse R; Vincent M; Nguyen U P; Chartrand C; Di Liddo L; Pastore Y^*

来源：Acta Paediatrica, 2017, 106(10): 1617-1623.

DOI：10.1111/apa.13859

• Hospitalisation
• Immune thrombocytopenia
• Prednisolone treatment
• Standardised protocol
• Step-down approach

Aim: Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use.
Method: A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded.
Results: The protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94-7.61) and 2.3 times less likely to receive treatment (95% CI 1.2-4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70).
Conclusion: Our ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications.

• 出版日期2017-10